Does the Thickness of Acellular Dermal Matrix Impact Outcomes of Prepectoral Implant-Based Breast Reconstruction?
Emily R. Finkelstein3, Federico Perez-Quirante3, Meaghan Clark*1, Samantha A. McLaughlin2, Sara Danker3, Juan R. Mella-Catinchi3, Devinder Singh3, Zubin Panthaki3, John Oeltjan3, Wrood Kassira3
1Ross University School of Medicine, Eagle, ID; 2University of Miami School of Medicine, Miami, FL; 3Plastic and Reconstructive Surgery, University of Miami School of Medicine, Miami, FL
Acellular dermal matrix (ADM) revolutionized prepectoral implant-based breast reconstruction (IBBR) by providing a barrier between a prosthesis and thin mastectomy flap. Despite its current widespread use, there is mixed evidence on whether ADM is associated with increased complications. This study evaluates whether ADM thickness has an impact on surgical outcomes in prepectoral IBBR.
The authors retrospectively reviewed cases of prepectoral IBBR with ADM from six surgeons between January 2017 to December 2022. Information on stages and timing of reconstruction, along with rates of four complications (infection, wounds or dehiscence, seroma, hematoma), reoperation for complications, and implant removal were compared according to ADM thickness.
A total of 547 patients underwent 849 reconstructions, of which 281 (51%) had direct-to-implant (DTI) and 266 (49%) underwent tissue expander (TE) reconstruction. Twenty percent of patients (n=113) developed a complication, with 18% (n=97) and 15.6% (n=80) requiring reoperation and implant removal. Medium thickness ADM had significantly fewer complications than either thick (29% vs 48%; p<0.0004) or extra-thick ADM (29% vs 54%; p<0.0001), and significantly fewer instances of wounds/dehiscence compared to both thick (14% vs 39%; p<0.0001) and extra-thick ADM (14% vs 43%; p<0.0001). Compared to extra-thick, medium thickness ADM approached significance for fewer infections (13% vs 20%; p=0.0652). Patients that received DTI reconstruction and extra-thick ADM had a significantly greater incidence of overall complications (p<0.0069), wounds (p<0.0028), and reoperation (p<0.0221) compared to patients with TE reconstruction.
Prepectoral IBBR with medium thickness ADM may lead to fewer overall complications, including wounds or dehiscence, compared to thicker ADM variations. Meanwhile, significant differences in the rate of complications for patients that received DTI versus TE reconstruction were only observed in patients with extra-thick ADM.
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